秋冬季節(jié)，幼兒園和小學(xué)的教室里經(jīng)常能聽(tīng)到小朋友們的咳嗽聲此起彼伏，咳咳咳，超過(guò)一個(gè)月的慢性咳嗽并不少見(jiàn)。爸爸媽媽們帶著醫(yī)院跑了好幾次，各路海淘的咳嗽藥水，民間偏方也試了個(gè)遍，就是斷續(xù)咳不停，一籌莫展。看來(lái)擒賊先擒王，應(yīng)該找到原因，標(biāo)本兼治才是王道！上次在12.3的欄目里小編和寶爸寶媽們一起學(xué)習(xí)了小兒呼吸學(xué)科專(zhuān)家們根據(jù)大樣本多中心研究的結(jié)果所總結(jié)出來(lái)的咱們中國(guó)兒童慢性咳嗽的常見(jiàn)原因，今天我們就來(lái)看看怎么來(lái)標(biāo)本兼治這個(gè)惱人的慢性咳嗽！想要溫故知新上一篇的爸媽請(qǐng)戳這里鏈接孩子咳咳咳，咳不停怎么回事 ---- 兒童慢性咳嗽知多少

　　讓我們先從排名前三位最常見(jiàn)的咳嗽原因開(kāi)始一一分解。各位爸媽小板凳拿拿好，瓜子茶水備備好，小編要開(kāi)講啦！

　　1.咳嗽變異型哮喘

　　⑴ 支氣管擴(kuò)張劑診斷性治療1-2周，吸入治療或口服。比如，丙卡特羅，特布他林，沙丁胺醇等；如果咳嗽緩解則有助于診斷；

　　⑵ 診斷明確后，選擇按照哮喘規(guī)范治療，療程至少8周；

　　--吸入糖皮質(zhì)激素（比如普米克，輔舒酮），或者；

　　--口服白三烯受體拮抗劑（順爾寧）；或者；

　　--吸入糖皮質(zhì)激素及口服白三烯受體拮抗劑聯(lián)合治療，

　　1.Cough- variant asthma:

　　⑴ A trial of bronchodilator inhaler or oral given for 1 to 2 weeks (Procaterol, Terbutaline or Salbutamol). It is mostly like cough-variant asthma if the child responds well.

　　⑵ When the diagnosis of cough-variant asthma is established, the treatment need to be lasted at least 8 weeks.

　　--- Inhaled corticosteroids (Pulmicort, Flixotide ); or

　　---Oral leukotriene Inhibitors (Singulair); or

　　--- Inhaled corticosteroids and oral leukotriene Inhibitors.

　　2.上氣道咳嗽綜合征

　　根據(jù)引起慢性咳嗽的不同疾病，采用不同的治療方案

　　⑴ 過(guò)敏性鼻炎：可以給予抗組胺藥物（比如仙特敏，開(kāi)瑞坦），鼻噴糖皮質(zhì)激素（比如內(nèi)舒拿，輔舒良）治療，或聯(lián)用白三烯受體拮抗劑 （順爾寧）等。

　　⑵ 鼻竇炎：需要使用抗生素治療至少2周，比如阿莫西林類(lèi)或阿奇霉素；輔以鼻腔黏膜減充血?jiǎng)┗蜢钐邓帯?br />
　　⑶ 增殖體肥大：根據(jù)程度，輕到中度者，一般采用鼻噴糖皮質(zhì)激素（比如內(nèi)舒拿，輔舒良）聯(lián)用白三烯受體拮抗劑 （順爾寧）觀察治療1-3月，無(wú)效可考慮采取手術(shù)治療。

　　2. Upper airway cough syndrome:

　　⑴Allergic rhinitis:  oral antihistamine medicines such as Zyrtec and Clarityne, corticosteroid nasal sprays such as Nasonex and Flixonase, and/or leukotriene Inhibitors singulair can be used.

　　⑵ Sinusitis: an antibiotic is needed for at least 2 weeks to zap the infection, such as Amoxicillin or Azithromycin. Nasal sprays can be used to ease congestion symptoms. Expectorants are applied to thin the mucus.

　　⑶ Adenoid hypertrophy: for mild to moderate ones, use intranasal steroids (Nasonex or Flixonase) and oral leukotriene Inhibitors (singulair) for 1 to 3 months. When medication does not correct the enlargement of the adenoid tissue, surgery is often needed.

　　3.(呼吸道)感染后咳嗽

　　一般來(lái)說(shuō)，感染后咳嗽不需要用藥治療，會(huì)自己慢慢好轉(zhuǎn)，但如果癥狀比較嚴(yán)重，影響孩子的生活學(xué)習(xí)和睡眠，可以考慮使用白三烯受體拮抗劑（順爾寧）或吸入糖皮質(zhì)激素（比如普米克，輔舒酮等）。

　　3. Post-infectious cough:

　　Generally, this condition is self-limiting and does not need treatment. If the cough cause significant impairment to sleep, meals or school, treatment is often need, such as leukotriene Inhibitors (singulair) or Inhaled corticosteroids (Pulmicort, Flixotide ).

　　除了以上3個(gè)引起最常見(jiàn)的兒童慢性咳嗽治療之外，那么其他常見(jiàn)的情況怎么治療呢？讓我們一起來(lái)看一看。

　　1. 特定病原體引起的呼吸道感染

　　多種病原微生物如肺炎支原體或衣原體，百日咳桿菌、結(jié)核桿菌、呼吸道合胞病毒，腺病毒等引起的呼吸道感染也可導(dǎo)致小兒慢性咳嗽，病程可>25天。可以根據(jù)相應(yīng)的病原微生物使用敏感藥物針對(duì)性治療。

　　1.Respiratory infections caused by various species of microbial pathogens can lead to chronic cough in children, including Mycoplasma pneumoniae, chlamydia, Bordetella pertussis, Mycobacterium tuberculosis, Respiratory syncytial virus, and adenovirus. The duration could be more than 25 days. Treatments target choosing sensitive medicine accordingly.

　　2.胃食管反流性咳嗽

　　使用H2受體拮抗劑（比如西米替丁)，胃動(dòng)力藥物 ，或質(zhì)子泵抑制劑(比如奧美拉唑）。改變體位，采取半臥位或俯臥前傾30度；改變食物性狀，少量多餐；避免引起返流的食物,比如高脂肪，油炸，酸性食物（橙汁，番茄），巧克力，薄荷，咖啡，洋蔥，大蒜及辛辣食物等，忌飽食。如果治療8周無(wú)效，則需考慮其他原因。

　　2.Gastroesophageal reflux-related cough (GERD)：

　　Helpful therapies in children include H2 antagonists (Cimetidine), prokinetic agents, or proton pump inhibitors. Lifestyle changes are often needed. Elevate the head of the child's bed while she/he sleeps to minimize coughing. For older kids, cut back on foods that typically set off symptoms of GERD, such as fatty or fried foods, citrus fruits, tomatoes, chocolate, peppermint, garlic, onion, and anything spicy. If it is not responsive after 8 weeks treatment, then etiologies for cough need to be reassessed.

　　3.非哮喘性嗜酸粒細(xì)胞性支氣管炎

　　對(duì)支氣管擴(kuò)張劑無(wú)效，吸入或口服糖皮質(zhì)激素有效（比如普米克，輔舒酮，必可酮），治療后咳嗽很快消失或者明顯減輕，每天兩次，一般持續(xù)用藥四周以上。

　　3.Nonasthmatic eosinophilic bronchitis

　　This cough generally does responds to bronchodilators but response to the inhaled corticosteroids (Pulmicort, Flixotide, or Becotide). The treatment is twice a day for more than 4 weeks.

　　4.異物吸入

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